_______
“When your patient dies, it doesn’t end there,” our pathology lecturer informed us in a matter-of-fact manner. There was such a detached air of authority about him; he was so knowledgeable about such grave matters, so fascinated by the science he was imparting, and yet seemingly so impervious to the humanity of it all.
He had been showing us slides of diseased organs: blood vessel walls furred with thick flaking gunge, lungs destroyed by smoking and chronic bronchitic changes, brains and heart muscle starved of oxygen, stomach walls eaten away with cancerous ulceration, fungating tumours of every description and visceral organs in different stages of discolouration and disease.
“You follow your patient through their hospital stay, into the mortuary, and through the post mortem. You find out all you can about how and why they died. You look at everything the body can tell you. How many of you have been to the post -mortems held every lunchtime?” Not many of us put our hands up, but we could guess who would.
“Every lunch time there is a notice pinned up on the board, with the names and times of all the post -mortem demonstrations,” the lecturer continued, probably appalled by the low uptake. “I want to see you all here.”
The first patient I ever clerked as a clinical year student (the third year of medical school training in those days) was a middle -aged man with spiky silvery hair. I cannot remember his name, just his diagnostic label and the outcome – is that sad? – but I can still see him sitting up in his hospital bed as I approached. A gentle man, softly spoken and with a warm and engaging manner. Whatever he was going through, he had a reassuring smile. I spent over an hour with him that first day, talking to him as he told me his personal and medical history, the symptoms he had and how he first noticed them, how they had developed and how he felt.
I examined him – awkwardly; a small hand on a large firm, slightly jaundiced body, palpating and percussing his abdomen to examine the organs that we had been taught were in there – flicking for the liver edge, pushing deep for the spleen and kidneys, checking for fluid and listening for the tinkling noises of intestinal gurgles. He did not flinch when I asked him to turn onto his side so that I could probe into his rectum (“examine your back passage”, we had been taught to say, and “breathe through your mouth as I put my finger in”). No need for a chaperone either. Patients were like that – they seemed to let us medical students poke around in all sorts of awkward ways as we attempted to master the clinical skills that would become the bread and butter of our work. I checked his X-rays, his temperature and blood pressure charts hanging at the foot of his bed, and most mornings I would come to talk to him to find out how he was doing and just to have a social chat. That was the real bonus – for both patient and student – to have the time to talk to each other. It was often at these more informal and personal times when patients asked about what they feared most. Sadly, we were never taught how to handle it apart from being told to direct such questions to the doctors. I am told things are different now; difficult situations and the breaking of bad news are role played by medical students under supervision.
But back to my first patient. The day of his surgery arrived, and I followed him into the operating theatre, talking to him and being with him as he entered the anaesthetic room. I attempted, unsuccessfully, to put a venflon and intravenous drip into the back of his hand, and when he was under the anaesthetic I was shown his windpipe, and how to intubate him. He had a laparotomy to open up his abdomen – just to see if there was anything surgically that could be done to alleviate some of his symptoms. There was not, so he was stitched up again and wheeled out of theatre and back to the ward.
As the days passed, he became more and more jaundiced, but his hands held mine with the same warmth and reassurance as they had before. One autumnal morning … I remember his name now, but I shall call him Ernest… he died. I never had a chance to say goodbye, or to see his relatives. My next encounter with Ernest was at his post-mortem, with his naked body cut open and his cancerous pancreas on display for all to see. Somehow, I had to detach myself, to forget that he had been that warm, welcoming human being, and just concentrate on his diseased organs and the medical jargon that went with it. I think that was the way most of us dealt with it. A lot of black humour and laughter. Making macabre jokes of quite awful human tragedies – either in the context of the annual medical college Christmas show, or when relaxing within our own social group of friends.
Some years ago I read a most extraordinary and disturbing novel called ‘Being Dead’. It spoke about the physical nature of death in great detail, the decay and decomposition, yet at the same time it tried to convey a sense of life through the relationship of an ordinary middle-aged couple. I still do not know whether or not I like the book, though it was undoubtedly extremely well written. But I found it too raw, too detached. I think we lived life as medical students, in a rather theme park or fairground manner – getting into rides one after the other, not knowing where they might take us and without the time to think about of the consequences. We were pushed along the queue by peers and supervisors herding us into the jaws of exhilarating uncertainty and adrenaline-driven encounters. We went through rollercoasters of emotions and experiences no one in their teens should have to go through; the hurdles and horrors, the dizzy highs and the gut-wrenching lows. There was little in the way of pastoral care. We did have a professor assigned to a small group of us, but I think we only met up once or twice a year at most. I recall going to his home and being served curried eggs. A fellow student found them so awful he hid his in a flower pot in the professor’s garden.
As the months went by, every long day was immersed in disease, illness, surgery and death. But what I remember most was our unquenchable thirst for life – to experience life, to marvel at the natural beauty that was all around us. On our regular Wednesday afternoons off, my boyfriend and I would take the underground train to Lancaster Gate, running through the greenery and fresh air of Hyde Park, along the Serpentine and onto the familiar statue of Peter Pan. Sometimes we played like school children, he kicking up the fallen autumn leaves whilst I tried to catch one as they fell. We looked for squirrels as they scurried about, burying nuts for the coming winter, or fed the ducks and swans in the nearby lake outside Kensington Palace. In the evening, we would queue outside a West End theatre box office, waiting for student standby tickets, or secret ourselves in the darkness of a cinema, where the huge screen and loud soundtrack overwhelmed the senses – and made us forget.
That summer London was filled with life, and a real sense of a new beginning. Prince Charles was to marry Lady Diana Spencer, a young, shy woman who stood with her head down, but had a rather awkward, secretive smile that made one warm to her. She was demure and looked regal, despite her schoolgirlish charm. There was much talk about how she had to submit to ‘an internal examination’ to make sure she was untouched by another man, so as to avoid any possible scandal. Lady Diana was even younger than myself, and I was astounded that a contemporary of mine, who lived in Kensington (a place I frequented every Saturday when I visited a school friend who was studying at one of the colleges nearby) was taking on such an enormous role.
When I was about nine, my parents came home with our first rented television, a small black and white Rediffusion set with little knobs down the side. It was always breaking down, and the technician would take ages to repair it as he waited for parts. Except on special occasions, we were allowed one hour viewing a day. We seldom used the allocation. One of the first broadcasts I ever saw was the investiture of the Prince of Wales at Caernarfon Castle. I remember watching his solemn oath to the Queen. Later, the oath was published in full in the South China Morning Post, the main English newspapers in Hong Kong. We soon had a popular version of our own in the school playground, where I was a member of a group akin to that in Enid Blyton’s Secret Seven stories, with our own little adventure house hidden at the end of a pebbly path.
My boyfriend and I spent the eve of the Royal Wedding up in Hyde Park, watching, along with thousands of others, the spectacular fireworks display that was held in the couple’s honour. It was an historic and unforgettable evening, made more so by the fact that all tube stations closed before the crowds had a chance to get to them. They even closed the gates to the park, with thousands still in the grounds, and we had to climb over. The few night buses that were around were packed with people, so in the end we had no option but to walk home – from Hyde Park to Bromley by Bow, past some of the most iconic London landmarks and through some of the most famous streets of London. Luckily, the weather was perfect for walking. Surprisingly, it did not feel in any way unsafe either, walking through the streets of London in the early hours of the morning. Everyone we passed along the way was merry and happy, as a wave of euphoria swept the nation. It made the whole royal fireworks event all the more memorable, and ‘something to tell the grandchildren’ in the years to come.
When we arrived back at our small hard-to-let council flat on the seventh floor of a run-down East End council estate, there was no time to sleep. Instead, my flatmate, my boyfriend and I sat glued in front of our small television, feet soaking in basins of warm water, drinking a bottle of champagne to toast the royal couple. It was like a fairytale made real, from the majestic music to the rousing cathedral bells, from the crowds lining the route waving their flags to the pomp and ceremony of the wedding itself and from the appearance of the newlyweds on the balcony of Buckingham Palace to that first kiss. Yet there was more. There was the shyness of the bride in her dazzling wedding dress, and the nervousness in her voice when making her wedding vows. The groom, on the other hand, seemed rather used to it all as he nonchalantly placed his gloves back on his hands without looking at his bride as they came out of St Paul’s Cathedral. One could sense that he was ready for the show.